Provider Demographics
NPI:1932205994
Name:CHARLTON, JOHN L III (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:CHARLTON
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 ROLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2220
Mailing Address - Country:US
Mailing Address - Phone:410-433-1122
Mailing Address - Fax:410-433-1122
Practice Address - Street 1:5013 ROLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2220
Practice Address - Country:US
Practice Address - Phone:410-433-1122
Practice Address - Fax:410-433-1122
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01077213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT304JLOtherBS
0974140002OtherADMINISTER FED
MD52069802OtherBCBS
MD090608500Medicaid
MD090608500Medicaid
MDMDT304Medicare ID - Type Unspecified